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AI/AN clients were also more likely to exhibit greater prescription opioid use and methamphetamine co-use relative to other groups. AI/AN clients in the South (aOR0.23[95 %CI 0.19-0.28] or referred by criminal justice sources (aOR0.13[95 %CI 0.11-0.16] were least likely to receive MOUD. We conclude that most AI/ANs in specialty treatment do not receive medications for opioid use disorder, and that rates of MOUD use are similar to those of other race groups. Efforts to expand MOUD among AI/ANs that are localized and cater to unique chara